April 18, 2011

Stanley Kurtz on the IPAB, Obama, and Socialism

They're back. Rationing, death panels, socialism, all those nasty old words that helped bring Republicans victory in 2010, and that came to seem so impolite after November of that year. They're back because of IPAB. Remember that acronym. It stand for The Independent Payment Advisory Board. IPAB is the real death panel, the true seat of rationing, and the royal road to health-care socialism. President Obama won't admit to any of that, but his speech in response to Paul Ryan's plan did push IPAB out of the shadows and into public view, however briefly. If Republicans don't seize the IPAB issue and run with it, they'll be losers in 2012. Policy wonks and political junkies may know a bit about this health-care rationing panel, but most Americans have barely heard of it. That has got to change. And the only way to expose and explain the dangers of IPAB is to tell the truth about Barack Obama.

In his speech on the deficit, Obama pointed to IPAB as an answer to Paul Ryan's plan. In Ryan's vision, competition among insurers will force efficiencies and lower prices. Under Obama's plan, in contrast, health-care prices for the elderly would be controlled by IPAB. Ryan's plan puts consumers in the driver's seat, but also exposes them to the risk of bad choices and limited subsidies. While Obama's plan offers government-guaranteed care, IPAB's price controls will lead to one-size-fits-all rationing. As IPAB caps Medicare payments for various services, the elderly will be unable to obtain many kinds of care, or will experience de facto rationing via long treatment delays and sharp declines in the quality of care. And by the way, IPAB rationing will hit many current seniors, whereas Ryan's reform of Medicare will never affect anyone now 55 or older.

So far so good. It sounds like we're in for a much-needed debate over competing public-policy visions: freedom of choice, with all it's risks, versus bureaucratic rule, with its mixture of guarantees and deprivations. Yet there's a lot more going on here than a straightforward policy debate. That's because Obama doesn't want to tell you in detail what his alternative to Ryan actually involves, especially when it comes to IPAB.

A month ago here at NRO, my EPPC colleague James Capretta described the real plan by which the president and his allies aim to close the fiscal gap. Their goal, says Capretta, is to work by stealth, so voters never fully realize that the government has adopted their strategy. The first part of the plan involves taxing "the rich" for Medicare and health insurance, but without Reagan-style indexing of taxes to inflation. That way, inflation-driven "bracket creep" will raise health-care taxes on the middle class without congressional Democrats ever having to vote for new taxes. (See Ross Douthat on this today.)

The second part of the plan involves IPAB-imposed price controls and the large-scale rationing of health care that implies. But to work, IPAB's authority has got to extend beyond Medicare. The idea, says Capretta, is to wait until the massive financial strains brought on by Obamacare bring calls for cost control. That's when the Democrats will push for IPAB's authority to be extended beyond Medicare to all of Obamacare, at which point we'll be very close to a single-payer health-care system with Canadian-style rationing.

As Kurtz goes on to point out, Obama has answered Ryan's plan by making class-warfare-themed opposition to the Bush tax cuts the centerpiece of his 2012 campaign, while continuing to stealthily consolidate his socialist plans for health care. The question for Republicans is whether or not they have the guts to expose Obama's strategy and call him on it, as they did in 2010. Will they go after IPAB and the permanent health-care rationing regime Obama means to cement in place, or will they merely defend Ryan's proposal against the avalanche of attacks sure to come?

And while we're on the topic of rationing, liberals like to argue that there's already health care rationing by insurance companies (look no further than this commenter at Kurtz piece), and that Obama's rationing panel is no different than what insurance companies have long-been doing. However, as David Rivkin and Elizabeth Price Foley wrote in their WSJ piece in December 2010 titled Death Panels Come Back to Life, there's an enormous difference between government-imposed rationing and treatment decisions in the private sector:

When insurance companies deny coverage -- for example, on grounds that treatment is "experimental" or not "medically necessary" -- they do so based on contract language agreed to in advance by subscribers. If you don't like what a particular insurer offers, you're free to shop around. Moreover, you and your doctor have extensive rights to appeal the insurer's denial, and wealthy patients can pay for the care out of their own pockets.

But when the government denies approval of a medication, there will often be no appeal and no escape. ...

Which is exactly where Obama's IPAB and its "royal road to health-care socialism" that Kurtz speaks of will take us ... to a point of rationed care with no appeal and no escape. And then there's all the financial cost involved in tetting there.

They're back. Rationing, death panels, socialism, all those nasty old words that helped bring Republicans victory in 2010, and that came to seem so impolite after November of that year. They're back because of IPAB. Remember that acronym. It stand for The Independent Payment Advisory Board. IPAB is the real death panel, the true seat of rationing, and the royal road to health-care socialism. President Obama won't admit to any of that, but his speech in response to Paul Ryan's plan did push IPAB out of the shadows and into public view, however briefly. If Republicans don't seize the IPAB issue and run with it, they'll be losers in 2012. Policy wonks and political junkies may know a bit about this health-care rationing panel, but most Americans have barely heard of it. That has got to change. And the only way to expose and explain the dangers of IPAB is to tell the truth about Barack Obama.\n\nIn his speech on the deficit, Obama pointed to IPAB as an answer to Paul Ryan's plan. In Ryan's vision, competition among insurers will force efficiencies and lower prices. Under Obama's plan, in contrast, health-care prices for the elderly would be controlled by IPAB. Ryan's plan puts consumers in the driver's seat, but also exposes them to the risk of bad choices and limited subsidies. While Obama's plan offers government-guaranteed care, IPAB's price controls will lead to one-size-fits-all rationing. As IPAB caps Medicare payments for various services, the elderly will be unable to obtain many kinds of care, or will experience de facto rationing via long treatment delays and sharp declines in the quality of care. And by the way, IPAB rationing will hit many current seniors, whereas Ryan's reform of Medicare will never affect anyone now 55 or older.\n\nSo far so good. It sounds like we're in for a much-needed debate over competing public-policy visions: freedom of choice, with all it's risks, versus bureaucratic rule, with its mixture of guarantees and deprivations. Yet there's a lot more going on here than a straightforward policy debate. That's because Obama doesn't want to tell you in detail what his alternative to Ryan actually involves, especially when it comes to IPAB.\n\nA month ago here at NRO, my EPPC colleague James Capretta described the real plan by which the president and his allies aim to close the fiscal gap. Their goal, says Capretta, is to work by stealth, so voters never fully realize that the government has adopted their strategy. The first part of the plan involves taxing \"the rich\" for Medicare and health insurance, but without Reagan-style indexing of taxes to inflation. That way, inflation-driven \"bracket creep\" will raise health-care taxes on the middle class without congressional Democrats ever having to vote for new taxes. (See Ross Douthat on this today.)\n\nThe second part of the plan involves IPAB-imposed price controls and the large-scale rationing of health care that implies. But to work, IPAB's authority has got to extend beyond Medicare. The idea, says Capretta, is to wait until the massive financial strains brought on by Obamacare bring calls for cost control. That's when the Democrats will push for IPAB's authority to be extended beyond Medicare to all of Obamacare, at which point we'll be very close to a single-payer health-care system with Canadian-style rationing.

Read more here...\n\nAs Kurtz goes on to point out, Obama has answered Ryan's plan by making class-warfare-themed opposition to the Bush tax cuts the centerpiece of his 2012 campaign, while continuing to stealthily consolidate his socialist plans for health care. The question for Republicans is whether or not they have the guts to expose Obama's strategy and call him on it, as they did in 2010. Will they go after IPAB and the permanent health-care rationing regime Obama means to cement in place, or will they merely defend Ryan's proposal against the avalanche of attacks sure to come? \n\nAnd while we're on the topic of rationing, liberals like to argue that there's already health care rationing by insurance companies (look no further than this commenter at Kurtz piece), and that Obama's rationing panel is no different than what insurance companies have long-been doing. However, as David Rivkin and Elizabeth Price Foley wrote in their WSJ piece in December 2010 titled Death Panels Come Back to Life, there's an enormous difference between government-imposed rationing and treatment decisions in the private sector:

When insurance companies deny coverage -- for example, on grounds that treatment is \"experimental\" or not \"medically necessary\" -- they do so based on contract language agreed to in advance by subscribers. If you don't like what a particular insurer offers, you're free to shop around. Moreover, you and your doctor have extensive rights to appeal the insurer's denial, and wealthy patients can pay for the care out of their own pockets.\n\nBut when the government denies approval of a medication, there will often be no appeal and no escape. ...

Which is exactly where Obama's IPAB and its \"royal road to health-care socialism\" that Kurtz speaks of will take us ... to a point of rationed care with no appeal and no escape. And then there's all the financial cost involved in tetting there.\n